Stanford Global Health Neurology Program - Nirali Vora

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Nirali Vora’s story

I didn’t know what to expect upon arriving to this sub-saharan African nation with no specialty-trained neurologists. I kept my mind and eyes open and searched for needs that we might be able to help target in a low-cost manner. In addition to a plethora of bedside teaching and lectures, what unfolded was the project of a lifetime – the opportunity to redefine stroke care in the nation of Zimbabwe.

In the US and resource-rich countries, we follow strict evidence-based guidelines to manage stroke patients. Day after day in the halls of Pari, I consulted on stroke patients lying in their cots with little to no plan. In discussion with the consultant physicians, I learned that there is a high risk of hemorrhagic stroke and concern for initiating medications like aspirin (which are available and affordable) without imaging. That there is limited rehab. That families correlate healing to eating (no npo after stroke). Meanwhile, an MMED (resident equivalent) had IRB approval to look at post-stroke mortality and found aspiration pneumonia as the highest cause of death. In conjunction with the MMED and Dr. Ngwende, the de-facto internist-turned-neurologist, we devised a treatment algorithm to optimize secondary stroke prevention even without imaging. This included adjustments in resource allocation, nursing measures to reduce aspiration, and a long-term plan to incorporate increase rehabilitation. We plan to measure the change in outcome after this intervention completes.

I welcome any interested residents and faculty rotating to Zimbabwe to continue working on this important project. Read more about my personal experiences both in and out of the hospital on my blog